Managing Treatment Side Effects

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Side effects, like treatment programs, vary from person to person. They can be unpleasant, but most often they are temporary, and most are treatable. Typical side effects for the most common cancer treatments include:

Surgery: During surgery, complications may include bleeding, organ damage and organ dysfunction. After surgery, side effects include pain and infection.

Some chemotherapy drugs may cause cardiac toxicity, or damage to heart muscle. Cardiac toxicity may lead to changes in heart rhythm (arrhythmias) or to heart failure. The chemotherapy drugs called anthracyclines are the most common cause of cardiac toxicity in cancer patients. These dugs include Adriamycin (generically called doxorubicin; other brand names are Doxil and Rubex), Cerubidine (daunorubicin) and Ellence (epirubicin), among others. Other drugs known to cause cardiac toxicity include Novantrone (mitoxantrone) and Herceptin (trastuzumab).

To prevent cardiac toxicity: If you are taking chemotherapy that might cause heart damage, your doctor will closely monitor your heart function and watch for signs of cardiac damage from these medications. It is likely that you will have an initial assessment made of your heart function before you start treatment for comparison purposes. You should alert your doctor immediately if you notice any symptoms of cardiac toxicity such as fatigue, shortness of breath, or swelling of the legs or ankles.

As with all drug treatment, the risks must be weighed against the benefits. In most patients with cancer, the potentially toxic effects of chemotherapy are justified in order to get the cancer into remission. This is not always the case, and you should tell your doctor whether you've ever had any type of heart condition, including high blood pressure. You should also inform him/her about any radiation treatment to the chest area that you might have received in the past.

Treating cardiac toxicity: If you develop cardiac toxicity, your doctor will stop or reduce the dose of the medication causing the heart damage. You may also receive medications to thin your blood and make it easier for your heart to pump more efficiently. Other medications used to treat heart failure include:

Diuretics: There are several types including thiazide, loop diuretics, and potassium-sparing diuretics; they help rid your body of fluid and sodium.

ACE inhibitors: These medications open up blood vessels and decrease the work load of the heart. These have become an important part of treatment.

Digitalis drugs such as digoxin (Lanoxin): These medications increase the ability of the heart muscle to contract properly and prevent heart rhythm disturbances.

Beta-blockers: These medications slow the nerve impulses that travel through the heart and decrease the risk of heart arrhythmia.

Fatigue

To avoid fatigue, plan your days so you have time to rest, especially around treatment times. Save your energy for activities that are most important to you and ask for help with the rest.

Report symptoms of fatigue to your doctor because fatigue caused by anemia should be diagnosed and treated promptly, so it won't interfere with your treatment schedule.

Fatigue can also be a sign of depression, a not uncommon response to the stress of cancer diagnosis and treatment. If your doctor rules out other causes of fatigue, ask for a referral to a psychotherapist who specializes in treating people with cancer.

Hair, Nail and Skin Issues

Be especially careful with your skin in areas where you're receiving radiation therapy. While you're being treated, don't rub your treated skin, wear tight clothing over it, use hot pads or cold packs on the area of treatment, or expose your skin to the sun.

Use only skin care products that your doctor or nurse has approved. Ask your medical team for recommendations.

Cancer-related hair loss can be especially distressing. Many people plan ahead by buying a wig that matches their hair color before starting treatment. Some insurance plans cover the cost of wigs, and there are organizations that specifically help cancer patients cope with hair loss, including the American Cancer Society sponsored sites, Look Good, Feel Better and Look Good Feel Better for Men.

Before using makeup or false eyelashes to compensate for loss of hair around the eyes, check with your doctor because your skin might temporarily be too sensitive to handle such enhancements.

If you lose your head hair, wear sunscreen on your scalp, and cover your head when you go outside in the sunlight or cold.

When hair begins to grow back, treat it gently, and don't color your hair for at least six months after treatment has ended.

Research has shown limited success in preventing hair loss during cancer treatment using two methods: scalp hypothermia (basically, icing the scalp during chemo treatments) and applying Rogaine (minoxidil). Neither has proven more than mildly successful.

Infections

Tell your doctor if you have any signs or symptoms might indicate infection, such as pain, fever or swelling.

If an infection is diagnosed, take the full course of medication that's prescribed for you.

Lymphedema

If you have a mastectomy with axillary dissection (removal of the breast and lymph tissue under the arm), you may develop swelling, or lymphedema. This is a symptom that should be reported to your doctor right away.

Lymphedema can be treated with:

compression bandages or pneumatic compression pumps

specific exercises prescribed by a physical therapist

a massage procedure called manual lymph drainage that pushes fluid and waste to drain properly

surgery in some cases

Mouth Sores

As a result of some cancer treatments, red sores or ulcers can form on the mucous membrane inside the mouth or on the lips. These sores can make it difficult to talk, eat, breathe comfortably and swallow, so it's important to let your doctor know about any mouth symptoms such as pain or sensitivity to heat or cold.

To prevent mouth sores:

Visit a dentist before you begin treatment to take care of existing issues such as cavities or gum infections.

Brush and floss your teeth after each meal to keep your mouth in good health; use a soft brush or ask your doctor about nonirritating teeth cleaning.

Stop smoking because smoking decreases the ability of mouth tissue to heal itself if sores develop.

During chemotherapy treatments, munch on ice chips; this limits the amount of the drug that reaches mouth tissue and thus helps prevent sores.

Treatments for mouth sores:

Coating agents are medications that coat the mouth lining and form a protective film that can lessen the pain of eating or drinking.

There are also topical pain relievers that you can apply directly to mouth sores. Because they cause numbness, be careful not to injure your mouth when eating or brushing your teeth.

Ask your doctor about a medication called Kepivance (palifermin), which is approved to stimulate the growth of cells in the mouth in people with some cancers. Some cancer centers may offer low-energy laser therapy to stimulate cell growth after chemotherapy and during and after radiation therapy.

Avoid acidic, spicy or irritating foods (such as chips or pretzels), as well as caffeine and alcohol. Also avoid excessively hot or cold food and drinks.

Use a straw for drinking liquids to keep the liquids away from mouth sores.

If you use a mouthwash, make sure it doesn't contain alcohol. You can also use slightly salted plain water to rinse out your mouth. Use the softest brush possible to clean your teeth, or use foam swabs made for sensitive mouths.

There are three main types of cancer-treatment related nausea, mostly associated with chemotherapy, but also sometimes with radiation therapy. Prevention and treatment strategies vary depending on which kind you might have:

Anticipatory nausea: Often doctors prescribe benzodiazepines such as Ativan (lorazepam) or Valium (diazepam) to prevent anxiety and thus quell anticipation of nausea and vomiting. They might also suggest that you stop taking stomach-irritating pain relievers such as the nonsteroidal anti-inflammatory drugs such as ibuprofen, and that you take an over-the-counter stomach-soothing drug such as Prilosec or Pepcid AC.

Acute nausea and vomiting: The drugs of choice for treating acute chemo-related nausea and vomiting are the serotonin antagonists, which may be given orally or intravenously and include Zofran (ondansetron), Anzemet (dolasetron), Kytril (granisetron), and Aloxi (palonosetron).Your doctor might also prescribe a dopamine antagonist such as Compazine (prochlorperazine) or Reglan (metoclopramide), which work by keeping your brain from perceiving nausea.

Delayed nausea and vomiting: Steroids are often prescribed for nausea and vomiting that occur two to five days after chemotherapy treatment, because these drugs help soothe inflammation in the gastrointestinal tract. Emend (aprepitant) is an oral anti-nausea medication that can be taken the day of and for a couple of days after chemotherapy treatments for delayed nausea. To be effective, however, Emend must be given with a steroid (dexamethasone) and a serotonin antagonist such as Kytril, Anzemet or Zofran. Serotonin antagonists are also helpful alone in treating delayed nausea.

Other ways to help prevent and relieve nausea and vomiting associated with cancer treatment:

Eat and drink small amounts throughout the day, instead of having a few big meals.

Don't go into chemotherapy on an empty stomach; eat a small, light meal beforehand – toast and jam or cereal, for example.

Although there is little medical research to back this up, many people swear by ginger (in many different forms – tea, raw ginger, candied ginger) as a nausea reliever.

Again, there is little medical evidence to support the practice, but many people find that various forms of green tea seem to prevent or diminish nausea during cancer treatment.

Keep a record of your experience. If you do have nausea and vomiting, when does it happen – before, during or after treatment? Let your doctor or oncology nurse know about this, so they can recommend treatments.

Neuropathy

Neuropathy is numbness, tingling or a burning sensation in an area of the body that has sustained nerve damage. Some people develop neuropathy in the hands or feet, which is called peripheral neuropathy. This type of nerve damage can happen to cancer patients as a result of chemotherapy or radiation treatments, or sometimes because a tumor is pressing on a nerve.

If your nerves have been injured due to radiation treatment or by platinum chemotherapy drugs, your neuropathy may not ever go away entirely, or it may take a long time to improve after treatment stops. But you may still get relief and improvement by:

Getting physical therapy and an exercise plan from a therapist who is familiar with cancer treatment-related neuropathy

Treating and controlling conditions such as diabetes that can also contribute to neuropathy

Neutropenia

Neutropenia is a low level of neutrophils, a type of white blood cell that helps the body fight infection. Because chemotherapy destroys cells that grow quickly, white blood cells are often affected. Lower white blood cell counts can increase your risk of infection. A normal neutrophil count is between 2,500 and 5,000. When this count drops below 1,500 it is considered mild neutropenia. Severe neutropenia occurs when this count drops below 500.

If you have neutropenia it is extremely important to avoid getting infections. Here are some tips for decreasing your risk of infection:

Avoid germs. Wash your hands frequently and avoid others who are sick. Use a liquid hand sterilizer when you cannot wash your hands.

Avoid crowds. It's best to stay away from places where there are a lot of people such as shopping malls or public transportation. Consider going to these places at off-peak hours when they're less crowded.

Eat a balanced diet. Getting adequate nutrients will increase your energy and help you heal faster after your treatments. Consider working with a nutritionist to design the best eating plan for you and help you decide whether you should follow a neutropenic diet that limits your exposure to bacteria in food.

Avoid accidents and injuries. It's important to avoid even minor injuries such as cuts, scrapes or abrasions. A low white-blood cell count can make it difficult to heal and increase your risk of serious infection. If you cut yourself, clean the area immediately with soap and water and bandage as necessary.

Rest. Allow yourself time to rest and save your energy for focusing on your treatment. Plan your schedule according to when you have the most energy during the day.

Talk to your doctor. It's important to talk to your doctor about ways to manage neutropenia and to tell your doctor immediately if you develop any signs of infection, such as a fever, chills, cough, mouth sores, pains or general fatigue.

Treating neutropenia

Medications. Your doctor may prescribe medications called growth factors that help prevent and treat neutropenia by stimulating the production of white blood cells. Growth factors such as Neupogen (filgrastim), Neulasta (pegfilgrastim) and Leukine (sargramostim) are administered by injection under the skin, usually by patients themselves. Once your white blood cell count has returned to a normal level, these injections are no longer necessary.

Antibiotics. If you develop an infection your doctor may prescribe antibiotics. In some cases you may receive intravenous (IV) antibiotics that are injected directly into your bloodstream.

Signs of infection. Immediately report any signs of infection such as fever, productive cough, urinary problems or any signs of skin infection.

Pain

Don't be afraid to ask for pain medication. You are the only one who knows what level of pain you can tolerate.

If your doctor prescribes pain medications, take them exactly according to the instructions – in the correct dosages at the correct times. Pain drugs work most effectively if you take them before pain becomes severe.

If the medicines don't work as well as you expected, talk to your doctor or nurse about switching to something else.

Always report any increase in pain or pain in an area where there wasn't any before. It could be a sign of a problem that needs further intervention.

Tell your doctor if you have any signs or symptoms that might indicate infection, such as pain, fever or swelling.

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